{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T14:35:16Z","timestamp":1788791716957,"version":"build-2803163510"},"reference-count":14,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2018,7,30]],"date-time":"2018-07-30T00:00:00Z","timestamp":1532908800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Introduction: Few studies have compared the dependence to different tobacco and nicotine products. Even less is known about how it relates to dependence on other common drugs, e.g., caffeine. In this study degree of dependence was compared between snus, cigarettes, nicotine replacement (NR), electronic cigarettes and coffee. Methods: A random sample of Swedish citizens belonging to an internet panel were contacted from September to October 2017. The responders were asked among other related things about their use of snus, NR, traditional cigarette or e-cigarette use and coffee consumption. The indicators of dependence used were: (A) the Heavy Smoking Index, (B) The proportions that used within 30 min after raising in the morning, (C) rating the first use in the morning as the most important and (D) Stating that it would be very hard to give up entirely. Results: Significantly fewer coffee drinkers started use within 30 min of awakening compared with all other products. The first use of the day was found to be more important for snus users compared with other products. On HSI there was no difference between snus and cigarettes. Snus and cigarettes were rated as being more difficult to give up than NR and coffee. Conclusion: Dependence to traditional cigarettes and snus seem to be relatively similar while NR was rated lower and coffee lowest. Since the prevalence of caffeine use in all forms is so much more prevalent than nicotine there might be more persons in the society heavily dependent on caffeine. Implication: Tobacco products are likely more dependence forming than NR products and coffee although there might be more people dependent on caffeine. The addiction to coffee or caffeine is seldom discussed in the society probably because of the little or no harm it causes. Funding: The Snus Commission in Sweden (snuskommissionen) funded the data collection. No funding used for the analysis and writing of manuscript.<\/jats:p>","DOI":"10.3390\/ijerph15081609","type":"journal-article","created":{"date-parts":[[2018,7,30]],"date-time":"2018-07-30T11:55:08Z","timestamp":1532951708000},"page":"1609","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["A Comparison of Dependence across Different Types of Nicotine Containing Products and Coffee"],"prefix":"10.3390","volume":"15","author":[{"given":"Karl","family":"Fagerstrom","sequence":"first","affiliation":[{"name":"Fagerstrom Consulting, 18531 Vaxholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2018,7,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_2","unstructured":"U.S. Department of Health and Human Services (1988). The Health Consequences of Smoking. Nicotine Addiction: A Report of the Surgeon-General."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1093\/ntr\/ntr137","article-title":"Determinants of Tobacco Use and Renaming the FTND to the Fagerstr\u00f6m Test for Cigarette Dependence","volume":"14","author":"Fagerstrom","year":"2012","journal-title":"Nicotine Tob. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/0376-8716(94)90158-9","article-title":"Predicting smoking cessation with self-reported measures of nicotine dependence: FTQ, FTND, and HSI","volume":"34","author":"Kozlowski","year":"1994","journal-title":"Drug Alcohol Depend."},{"key":"ref_5","unstructured":"(2017, September 12). Regarding Ethical Review of Research Involving Humans. 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Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"c6549","DOI":"10.1136\/bmj.c6549","article-title":"Stopping smokeless tobacco varenicline: randomized double blind placebo controlled trial","volume":"341","author":"Fagerstrom","year":"2010","journal-title":"BMJ"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.drugalcdep.2015.03.040","article-title":"Measurment of multiple nicotine dependence domains among cigarettes, non-cigarette and poly-tobacco users: Insights from item response theory","volume":"152","author":"Strong","year":"2015","journal-title":"Drug Alcohol Depend."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.drugalcdep.2008.08.001","article-title":"Caffeinated energy drinks\u2014A growing problem","volume":"99","author":"Reissig","year":"2009","journal-title":"Drug Alcohol Depend."},{"key":"ref_12","unstructured":"Royal College of Physicians (2016). Nicotine without Smoke: Tobacco Harm Reduction, Royal College of Physicians."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.drugalcdep.2008.05.001","article-title":"Use of nicotine replacement therapy among never smokers in the 1999\u20132006 National Health and Nutrition examination surveys","volume":"98","author":"Gerlach","year":"2008","journal-title":"Drug Alcohol Depend."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1093\/ntr\/ntx076","article-title":"Psychometric Properties of Fagerstr\u00f6m Test for Nicotine Psychometric Properties of Fagerstr\u00f6m Test for Nicotine Dependence for Smokeless Tobacco Users (FTND-ST)","volume":"19","author":"Mushtaq","year":"2017","journal-title":"Nicotine Tob. Res."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/15\/8\/1609\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T15:15:15Z","timestamp":1760195715000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/15\/8\/1609"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,7,30]]},"references-count":14,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2018,8]]}},"alternative-id":["ijerph15081609"],"URL":"https:\/\/doi.org\/10.3390\/ijerph15081609","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,7,30]]}}}